August 6, 2014

Book Review: Health Food Junkies

Note: I do not plan to have this blog become nothing but recipes, book reviews, and food label takedowns. I am still (slowly but surely) working on the project I've been mentioning for a while, and I'm also still figuring out where to go next in my "real" posts -- the ones that dive deeper into physiology and biochemistry. I don't want to parrot what a hundred other people out there are already covering, so what's a gal to do? Man, this niche-finding is harder than it sounds! Anyway, I will be getting back to more educational posts soon, but in the meantime, rather than have total blog silence, I hope nobody minds that I keep posting things like this. So here goes...

I expected to not like this book. I expected to be angry and disappointed throughout. I mean, come on, the book’s subtitle is Overcoming the Obsession with Healthful Eating. So before I even started, I wondered how the author, Steven Bratman, MD, would define “obsession” and “healthful eating.” Would he call me “obsessed with healthful eating” if he went out to breakfast with me and I ordered a western omelet (hold the toast), instead of a stack of pancakes dripping with syrup, washed down with a 20oz orange juice? Would he call me “obsessed” if I were at a restaurant and instead of taking a piece of bread from the complimentary basket, I helped myself to a pat of butter? Is that being “obsessed,” or is it simply me recognizing that my body doesn’t do so well on lots of sugar and starch? 

I expected this book to be a diatribe against anyone who asks questions of restaurant wait staff, or who asks for substitutions of double green vegetables in lieu of potatoes or pasta. Was I going to sit through 200+ pages of this doctor railing against people who eat Paleo, Primal, gluten-free, low-carb, or who are simply concerned with the sources of their food? If so, it was gonna be a bumpy ride.

TL;DR – THIS IS A GOOD BOOK! Read it if you’re at all interested in learning more about orthorexia or if you think someone you care about (possibly even you!) might be struggling inordinately with food issues, to the point where their quality of life is suffering. (BTW: After seeing it for so long on other people’s sites, I finally learned what tl;dr means! I should probably go back and add it to Every. Single. Post.)

I am happy to report that I was very pleasantly surprised by this book. I braced myself for some major trash-talking of people who take their health, diet, and physique seriously. But as the author explains so well throughout, there’s a difference between someone taking their diet and health seriously and them taking it so seriously that they cease to have a life, or, at least, cease to have a life that permits them to function in normal society, and that eventually interferes with relationships, employment, socialization, and health. People are right to be concerned about what they eat, and, truth be told, the average SAD-eaters out there probably should be far more concerned than they are. But when taken too far, hyper-vigilance about healthy eating starts to backfire, because health actually becomes worse—physical health, mental health, and sometimes both.

I suspect Dr. Bratman chose to write this book because he is intimately familiar with the subject, both as a practicing physician and as a former orthorexic, himself. In fact, he’s the one who originally coined the term, after seeing the conglomeration of signs so often in his patients, and recognizing that it might be easier to talk about if he could give it a name. Bratman is completely forthcoming with details from his history as (at various times) a raw foodist, vegan, fruitarian, and macrobiotic follower.

It is likely his own experience with orthorexia that enabled him to write this book in such a gentle, understanding, and judgment-free tone. Where I expected him to be condescending and insulting, he was understanding and empathetic. He knows only too well how delicate food issues are—to everyone, really, but particularly to people whose lives are ruled by food rules. So at times, he addresses things tenderly, and with kid gloves, but never without an appropriate dose of scientific scrutiny, nutritional reality checks, and, surprisingly, good humor. (That never hurts a book, especially one about a serious topic.)

I was surprised to note that this book came out in 2000—several years before the recent avalanche of books about veganism, Paleo, low-carb, raw foods, etc. Then again, there have always been whackjobs of some sort or other pedaling all manner of out-there diets, cleanses, and life-saving protocols. (All yours for just $19.99—BUT WAIT! Call now, and we’ll send two! Just pay shipping and handling!) Anyway, if you want to learn about some really wacky diet philosophies, all you have to do is dig a little into the history of Sylvester Graham and John Harvey Kellogg. (Creators of graham crackers and modern high-fiber, whole grain cereals, respectively—both designed to kill your libido, you lascivious, libidinous, filthy, sex-always-on-the-brain American! Shame on you! You should live like a monk and spend at least half your day on the toilet doing number 2. To quote Dave Barry [as I love to do], I am not making this up!) Seriously…didn’t anyone ever tell you you’d go blind…? Keep your hand away from there!)

Aaaaanyway, so why did I read this book? Well, it seems like there’s been a fair bit of talk about this in the blogosphere during the past few months, so I thought maybe I ought to learn more about it. It’s also not out of the question that I’ll come across a client or two that are either inching toward orthorexia, or are already drowning in it. Couldn’t hurt to get more familiar with the concept.

On the blogs & forums I frequent, I’ve read stories from people whose relationships have ended because of irreconcilable differences about diet. And then there are parents who are worried about visiting grandma for Christmas because she might slip their kids a slice of cheese, or—*gasp*—some wheat-containing cookies, and they’ll be peeling little Billy off the walls for the next two hours. But we need some context with these things. When there’s a genuine allergy or severe intolerance, of course you should be careful. If someone really does have terrible reactions to certain foods, then you do need to be vigilant, and maybe you need to have a serious talk with the extended family about respecting those boundaries. And if you honestly believe your significant other is doing themselves serious harm (and, by extension, disrespecting you in the process [albeit unintentionally], because you love them and want them to be healthy) by remaining (choose an adjective) obese, sedentary, hyperinsulinemic, in chronic pain, etc., then maybe that’s not such a great relationship to stay in anyway.
Iron fists: suitable for ruling fascist 
dictatorships; for your child's diet, 
not so much.

But these things can be taken too far. If Mikey always has to bring his own gluten-free cupcake frosted with coconut oil and local, raw honey to classroom birthday parties even though he has no known issues with gluten, and you’re micromanaging every crumb of his diet because you heard on a podcast that a rat study suggested he could become obese or get Parkinson’s 89 years down the line, then there might be some rethinking to do. (Note: I am not encouraging the consumption of sugar and partially hydrogenated cottonseed oil [which most frostings are made of]. I’m just making a point.)

So there’s a spectrum here. A continuum that increases by degrees. It goes from a healthy focus on…well, health, to an ├╝ber-vigilance that prevents you from participating in the world. (Or maybe you still manage to participate, but you sure ain’t enjoying it.) And Bratman does a great job of explaining the difference.

He shares stories of many patients, some who recovered and went on to have healthy, balanced relationships with food, and some who didn’t. He also gives practical, actionable advice for healthcare practitioners and concerned loved ones who believe someone they are treating or someone they care about might be falling into orthorexia. He explains what to look for and how to distinguish between someone who takes their diet seriously because it helps them live a better life, versus someone who no longer has a life because their every waking thought has been taken over by food. He advises on when to intervene and when to stay away, all with the same gentle understanding he uses throughout. He recognizes that while this is a delicate topic, and people need to be approached in a non-threatening way, there are situations that call for drastic interventions. There are circumstances that can become life-threatening. He details some especially heartbreaking cases of parents forcing their odd, semi-inexplicable food behaviors upon their children, which, if you ask me, borders on child abuse. (Emotional and psychological if not outright physical, via nutrient deficiencies.) And here I’m not talking about wanting grandma & grandpa to stop offering the kids ice cream and wheat bread, but about some seriously dangerous food restrictions being forced upon children who are unable to speak up for themselves.

Bratman covers several different food philosophies, poking holes in all of them. I like that he does this, because he takes full responsibility for falling prey to the weirdness of the methods he, himself, followed in the distant past. He talks about veganism, macrobiotics, the blood type diet, raw foods, anti-candida diets, the Zone diet (in which section he also dissects what he calls “the caveman diet,” in referring to Ray Audette’s book, Neanderthin, which was one of the only "Paleo" books on the market at the time). He’s correct in pointing out that, regardless of how fervently people might believe in these approaches to diet, they can’t all be right, because they contradict each other so sharply. How can a raw food diet and “the caveman diet” both be “the best” for health? (I think I and anyone reading this blog know they’re not, or we like to think we know, but hey, time and science could eventually prove us wrong. I don’t think they will, but you never know…)

Bratman’s humor really comes through in the sections where he tackles each of these diets individually. He’s respectful of the reasons why people find refuge in them, but he also opens dialogues by pointing out how ridiculous it all is. How can they all be magical healing diets when one says no animal foods, and another says liberal amounts of animal foods? One says no cooked foods; another says only cooked foods. It’s enough to make you give up and head to Wal-Mart for blueberry muffins at 4 for $1.00.

My only beef with Bratman (no pun intended, honest!) is that he emphasizes a vegetarian diet—one that includes lots of tofuas the best for health. In his defense, though, he stresses that this should be a lacto-ovo vegetarian diet, because he is well aware of the potential nutrient deficiencies induced by long-term veganism. (And this being said, he also emphasizes that diet truly needs to be individualized. The magic bullet for one person could be the kiss of death for the next. And even for the same person, what worked well when they were 25 might not work at all when they’re 65. His perspective is refreshingly balanced, which was probably the most pleasant surprise of all while reading this book.)

Here’s a direct quote:
“No known peoples have ever been vegan. That there’s basically no way to get enough of this essential vitamin [B12] without eating at least a bit of animal products is an indication that it isn’t really a healthy approach to diet.”

Fact: Man (and woman) cannot live by salad alone.

And even better: In order to convince a vegan patient to add back in some animal foods, he explained to her that “…no primal peoples known on the face of the earth had ever been vegan, and that the whole idea was really an invention of people who lived in Western countries and had too much time on their hands.”

HA! That reminded me of Chris Rock’s line about red meat: “What do you mean, ‘Red meat will kill you?’ Don’t eat no red meat? No, don’t eat no green meat. What'chu talkin' about?! If you’re one of the chosen few people on this Earth that's lucky enough to get your hands on a steak, bite the sh*t out of it!”

And as long as we’re quoting Chris Rock’s stellar insights on food (NSFW), let’s do one more: “We got so much food in America, we’re allergic to food. Allergic to food! Hungry people ain’t allergic to sh*t. You think anyone in Rwanda’s got a [f-ing] lactose intolerance?!”

And I have to say, I was quite pleasantly surprised at his take on the Zone and Paleo. (I’m tired of saying “caveman diet.” We know what he means.) He wasn’t too keen on the amount of fat or animal protein, but he was in agreement on the issues of blood sugar & insulin regulation, and said it was unlikely there would be any nutritional shortcomings on these plans. Overall, his treatment of these approaches is pretty nice, especially considering he’s a former raw vegan, which goes to show how far a medical/science education has broadened his perspective. 

The author saves his harshest critique for the blood type diet. (His opinion in a nutshell: it is total bullcrap.) He also shares tales of a couple of patients who were “living on tablets”—people who ate some amount of actual food, but who were obsessed with supplements. People whose lives revolved around their supplementation schedule. These were patients who’d show up at his office with a shopping bag full of pill bottles, and who actually wanted him to recommend more, not fewer. Oddly enough, I can relate. I’ve certainly never lost any quality of life to my supplement regimen, but on and off during the last 5 years or so, I’ve been pretty desperate to help myself. Maybe you can relate to some of this: After reading Julia Ross's classic, The Mood Cure, you can be sure I ran out and bought 5-HTP, tyrosine, DLPA, a stress formula that contained all kinds of herbal adaptogens…I could go on. It’s easy to fall into this as a nutritionist. When you start studying different nutrients and what they do, you tend to think you need more of whatever it is you’re currently fixated on, be it chromium, lipoic acid, tryptophan, B6… I have a drawer loaded with supplements, most of which I don't take and were a complete waste of money. (But sometimes you’ve got to experiment until you find the things that do work.) When you’re in a physical or psychological place you want to get out of, it’s easy to latch on to anything and everything you think might help. I think most experienced naturopaths out there have probably learned to just smile and roll their eyes when new patients show up with bags of pills in their hands and looks of desperation on their faces.
Sometimes, you can find relief in a bunch of pills. 
Not usually complete or permanent relief, though.

But just like with food, people can have orthorexia with pills, too. They’re looking for the fountain of youth, or the miracle cure for wrinkles, or cellulite, or weak nails, dry skin, low moods, or a perpetually flaccid penis. And they can’t leave the house because they’ve mastered their 82-pill-a-day regimen down to the nanosecond, and there are too many unpredictable variables in the outside world that might make them take their chelated manganese three quarters of a minute late.

But what makes someone orthorexic? What leads someone to believe “THE ANSWER” lies on a plate of carrots and brown rice arranged just so, or in a glass of wheatgrass juice, a slab of tofu, or, dare I say it, a grassfed ribeye? Bratman’s got some great theories about this, and they’re things you might have heard the likes of Robb Wolf, Mark Sisson, and Chris Kresser mention on their podcasts and in their blogs.

Robb Wolf said it best a while back on one of his podcasts. An aerobics instructor had written in and she was explaining her exercise schedule—including many, many hours of cardio machines, lifting, and running in addition to the multiple classes she taught every day. (And she was complaining of fatigue and, not so ironically [if you know anything about how the body works], weight gain.) Robb politely suggested that she ask herself what she was running from. Someone who buries themselves that deeply into running (or biking, swimming, lifting, what-have-you) is probably trying to escape from something. Theyre devoting inordinate amounts of time to exercise in order to avoid having to deal with something else in their life.

And here is where I think Bratman really hits the jackpot. What are the psychological factors that drive someone to become orthorexic? ‘Cuz let’s face it: there’s a big difference between being careful about where your food comes from and how you prepare it, and letting these issues control your life. And many orthorexics start out innocently enough. They start from a place of genuinely wanting to improve their health, physique, allergies, energy levels, or whatever, but somehow, they become convinced they’ve found some kind of holy grail that leads them not just to dietary perfection, but to perfection (or, at least, the promise of perfection) in the rest of their life as well.

He delves into a few of the potential thought patterns that move people from one end of the balanced-sanity spectrum to the other. All of them are logical and insightful, but I’ll focus on only a couple here, since this post is way too long already. (It seems this is my trademark. If I can’t be intelligent, I’ll be verbose.)

He talks about people using diet to feel superior. Ex: they eat “cleaner” than anyone they know. They’re not eating pizza and beer like their overweight mother/husband/friend/coworker. Bratman doesn’t specifically make the following connection, but I think this could be especially true for people with deep insecurities in other areas of their life: their career, their appearance, their finances, their marriage, etc. Dietary perfection gives them something to feel proud of, when they feel like there’s nothing else going right in their life. It’s one thing—maybe the only thing—they can hold over people’s heads and feel like they’ve accomplished something. Their neighbor might have their dream job, their dream car, and their dream wife, but dammit, they haven’t eaten a single grain of white sugar in 627 days, whereas neighbor guy eats Nutter Butters on his porch every night, so there! Abstainer clearly has a happier life! (And is a “better”/more morally righteous person, to boot!)

Here are some other lines that hammer home the author’s thoughts on different reasons that push people toward orthorexia. Some people are trying to avoid food allergens and end up being able to eat practically nothing; others fall under the incorrect assumption that changing their diet is enough to change the rest of their life—and that if they could just “be perfect” with what they eat, then the rest of their problems will magically disappear. And, of course, there are people who focus solely on diet because by becoming completely, 100% absorbed in food, they can conveniently ignore the things in their life that really need attention, but which are much more uncomfortable to acknowledge and deal with than what they put on their plate.

Regarding people who take food allergies too far:
“Do you really need to have a body that is absolutely, perfectly healthy and a mind that is never troubled or upset? … Do you really get as sick from minor allergens as you allow yourself to believe? How much of it do you exaggerate, even to yourself? Does it warm your heart to shake your head sadly and say, ‘No, I can’t eat that. It makes the skin on my third toe turn red.’ Could some of it be psychosomatic, a mental effect caused by your strong opinions against certain foods?”

(And again, I am not suggesting severe food allergies don’t exist, and neither is the author. Bratman acknowledges over and over again the healing he has seen in people who ditch things like gluten, dairy, and/or soy. He’s not talking about that. He’s talking about people who are seriously off the deep end with this stuff.)

“Psychologically, food allergies involve a kind of intolerance to all discomfort, all imperfection in the body…The net effect is a personality that holds little tolerance for any mood, discomfort, or disturbance. In a sense we become picky eaters at every level, not only of food but of all sensations.”


Another reason the author has identified that pushes people toward orthorexia is what he calls “the desire for complete control.” He explains it as: “Using the tiny world of food to 
convince yourself that your whole life is under your control.” Using macrobiotics as an example, he says, “You can focus all your angst on the important question of how best to slice the carrots and thereby avoid unpleasant subjects such as ‘What am I doing with my life anyway?’”

If food is doing this to you, you do not need another Whole30®, or another strict 30-day Paleo challenge. More likely, you need a break from being ruled by food rules. And possibly also professional help.

“Orthorexia is a simple solution, the author says. It frees us from thinking about the full range of issues that might matter in our lives and turns our attention toward one direction only: what goes into the mouth. It’s wonderful! The only problem is that it’s a lie.”

This reminds me of what I talked about in my post about vitamin J. Some health and quality of life issues have nothing to do with diet. No amount of tyrosine, bone broth, or liver, can change the fact that you feel trapped in a loveless marriage; stuck in an unfulfilling job; or suffocated under a mountain of debt. But controlling your diet—relentlessly, perfectly controlling your diet and nailing your supplement schedule down to the second—might give you some illusion of control. The feeling that you are steering your life, when the truth is, your life is collapsing all around you and you’re hanging on to micromanaging your food because it’s the only thing you feel like you can hang on to.

And making sure that you have exactly “x” grams of protein, fat, and carbs per day, every day, might get old after a while, but it’s a heckuva lot more comfortable than taking serious stock of your life and being scared, disgusted, or ashamed of what you see when you do. If only you could lose those last 4 pounds, then everything would be perfect. (No, it won’t. Believe me.) If only you could shave 32 seconds off your 10K time, then everything will fall into place. If only you could deadlift 40 more pounds. If only your spinach were biodynamic…

If only it were that simple, cupcake. If only it were that simple.

Remember: Amy Berger, M.S., NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition.


  1. I am a fairly new reader and wanted to thank you. I am enjoying your blog and love the varied subjects you cover. This one, unfortunately, applies to me to a degree. I am working on changing that.....relaxing and letting myself enjoy all the foods that life has to offer!

    1. Glad you like what you've found here so far. And good for you for recognizing that you might be taking things too far. There's a fine line between being careful about what we eat and honoring our bodies and our health, but honestly? Sometimes your soul just wants a donut! ;-)

  2. Verbose and intelligent (emphasis on the latter). Works for me, Amy.

  3. Great blog post, Amy. Wish I had read this when you wrote it....4 years ago!

  4. I have to wonder at times about your level of anger. I am not a nutritionist so can't really know what it must be like to encounter food obsessing people every day but I probably would not take it this personal.